The association between intraoperative cell salvage and red blood cell transfusion in cardiac surgery – an observational study in a patient blood 
management centre

Neef, Vanessa; Vo, Linda T.; Herrmann, Eva; Triphaus, Chris; Judd, Leonie; Winter, Andreas; Zacharowski, Kai; Choorapoikayil, Suma; Meybohm, Patrick

doi:10.5114/ait.2021.103735

Cited by 8 publications

(8 citation statements)

References 29 publications

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“…Although the use of red cell salvage is incorporated in PBM programmes, the cost effectiveness of cell salvage and the reduction of adverse outcomes by reducing allogeneic RBC transfusion requirements is still under debate. However, many studies suggest that cell salvage is associated with a decreased proportion of patients exposed to allogeneic RBC transfusions as an individual measure in a comprehensive PBM programme 409–414 …”

Section: Discussionmentioning

confidence: 99%

“…However, many studies suggest that cell salvage is associated with a decreased proportion of patients exposed to allogeneic RBC transfusions as an individual measure in a comprehensive PBM programme. [409][410][411][412][413][414] Although autologous platelet-rich plasmapheresis has been proposed as a blood conservation technique in complex cardiovascular surgery, whether it can improve clinical outcomes remains unclear. [415][416][417] The indications for autologous platelet-rich plasmapheresis require further study, particularly whether it is beneficial to lowrisk patients.…”

Section: Cell Salvagementioning

confidence: 99%

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Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

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108

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BACKGROUND Management of peri-operative bleeding is complex and involves multiple assessment tools and strategies to ensure optimal patient care with the goal of reducing morbidity and mortality. These updated guidelines from the European Society of Anaesthesiology and Intensive Care (ESAIC) aim to provide an evidence-based set of recommendations for healthcare professionals to help ensure improved clinical management. DESIGN A systematic literature search from 2015 to 2021 of several electronic databases was performed without language restrictions. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to assess the methodological quality of the included studies and to formulate recommendations. A Delphi methodology was used to prepare a clinical practice guideline. RESULTS These searches identified 137 999 articles. All articles were assessed, and the existing 2017 guidelines were revised to incorporate new evidence. Sixteen recommendations derived from the systematic literature search, and four clinical guidances retained from previous ESAIC guidelines were formulated. Using the Delphi process on 253 sentences of guidance, strong consensus (>90% agreement) was achieved in 97% and consensus (75 to 90% agreement) in 3%. DISCUSSION Peri-operative bleeding management encompasses the patient's journey from the pre-operative state through the postoperative period. Along this journey, many features of the patient's pre-operative coagulation status, underlying comorbidities, general health and the procedures that they are undergoing need to be taken into account. Due to the many important aspects in peri-operative nontrauma bleeding management, guidance as to how best approach and treat each individual patient are key. Understanding which therapeutic approaches are most valuable at each timepoint can only enhance patient care, ensuring the best outcomes by reducing blood loss and, therefore, overall morbidity and mortality. CONCLUSION All healthcare professionals involved in the management of patients at risk for surgical bleeding should be aware of the current therapeutic options and approaches that are available to them. These guidelines aim to provide specific guidance for bleeding management in a variety of clinical situations.

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Section: Discussionmentioning

confidence: 99%

Section: Cell Salvagementioning

confidence: 99%

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

Self Cite

108

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“…19 On the contrary, Neef et al found that cell salvage was significantly associated with a reduced number of allogeneic RBC transfusions. 20 Only 40% of patients included in our analysis required blood or blood product transfusion (Figure 2). There was no significant difference in blood transfusion requirements between the cell saver group and the no cell saver group.…”

Section: Discussionmentioning

confidence: 99%

The use of cell salvage in adult cardiac surgery at Queen Alia Heart Institute

Alsmadi,

Alhadidi,

Alawamleh

et al. 2024

Int J Adv Med

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Background: Objective of the study was to determine the incidence of use cell salvage, indications, efficacy in blood conservation and benefits on recovery after adult cardiac surgery. Methods: This is an observational analysis of adult cardiac surgical patients presenting for cardiac surgery at Queen Alia Heart Institute in the period between September 2023 and December 2023. Patients’ demographics, type of surgery (cardiac pathology), comorbidities, preoperative and postoperative laboratory results, blood transfusion requirements, extubation and intensive care unit (ICU) length of stay were recorded and statistically analysed to determine the effectiveness of cell salvage. Patients were divided into two groups: The cell saver group and the no cell saver group for comparison. Results: Data from 141 adult cardiac surgeries is included in this analysis. Indications for cell saver use were recent anticoagulation (41.4%), more complex surgery (20.7%), high risk of bleeding (13.8%), preoperative anaemia (6.9%), intraoperative major bleeding (6.9%), coagulopathy (6.9%) and rare patient blood type (3.45%). Patients from the cell saver group required blood transfusion 2.1% more than the no cell saver group. There was no significant difference in the length of hospitalization between those who had and those who had not cell saver used during surgery (11.9 and 12 days, respectively). Conclusions: Cell saver was used in one fifth of adult cardiac surgeries. Most common indications for cell saver use during cardiac surgery were recent anticoagulation and more complicated cardiac surgery. The use of cell saver had no impact on postoperative haematocrit or overall time of hospitalization.

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“…Blood sample collections should be reduced to the absolute necessary numbers, blood sample collection tubes should draw as little blood volume as possible, and return systems for blood sample collections should be established. Washed cell salvage—the collection, washing and retransfusion of a patient’s own wound blood—can help to reduce the need for blood from other sources [ 21 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Preoperative anaemia and red blood cell transfusion in patients with aneurysmal subarachnoid and intracerebral haemorrhage — a multicentre subanalysis of the German PBM Network Registry

et al. 2022

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Purpose Anaemia is common in patients presenting with aneurysmal subarachnoid (aSAH) and intracerebral haemorrhage (ICH). In surgical patients, anaemia was identified as an idenpendent risk factor for postoperative mortality, prolonged hospital length of stay (LOS) and increased risk of red blood cell (RBC) transfusion. This multicentre cohort observation study describes the incidence and effects of preoperative anaemia in this critical patient collective for a 10-year period. Methods This multicentre observational study included adult in-hospital surgical patients diagnosed with aSAH or ICH of 21 German hospitals (discharged from 1 January 2010 to 30 September 2020). Descriptive, univariate and multivariate analyses were performed to investigate the incidence and association of preoperative anaemia with RBC transfusion, in-hospital mortality and postoperative complications in patients with aSAH and ICH. Results A total of n = 9081 patients were analysed (aSAH n = 5008; ICH n = 4073). Preoperative anaemia was present at 28.3% in aSAH and 40.9% in ICH. RBC transfusion rates were 29.9% in aSAH and 29.3% in ICH. Multivariate analysis revealed that preoperative anaemia is associated with a higher risk for RBC transfusion (OR = 3.25 in aSAH, OR = 4.16 in ICH, p < 0.001), for in-hospital mortality (OR = 1.48 in aSAH, OR = 1.53 in ICH, p < 0.001) and for several postoperative complications. Conclusions Preoperative anaemia is associated with increased RBC transfusion rates, in-hospital mortality and postoperative complications in patients with aSAH and ICH. Trial registration ClinicalTrials.gov, NCT02147795, https://clinicaltrials.gov/ct2/show/NCT02147795

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The association between intraoperative cell salvage and red blood cell transfusion in cardiac surgery – an observational study in a patient blood management centre

Cited by 8 publications

References 29 publications

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

The use of cell salvage in adult cardiac surgery at Queen Alia Heart Institute

Preoperative anaemia and red blood cell transfusion in patients with aneurysmal subarachnoid and intracerebral haemorrhage — a multicentre subanalysis of the German PBM Network Registry

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